The Evolving Identity of Otolaryngology: Response from the Academy

The Evolving Identity of Otolaryngology: Response from the Academy

In a recent VIEWPOINT, Dr. Roland D. Eavey paints a broad vision for the future of otolaryngology, stating that “…while we have traditionally viewed ourselves as the ear, nose, and throat surgery industry, we are truly also in the communication industry”, and that “…we are the proud guardians of communication.”1 Dr. Eavey further notes that the specialty of otolaryngology is defined by communication.

We welcome Dr. Eavey’s interest in and commitment to the importance of human communication. However, we postulate that the effective diagnosis, management, and treatment of disparate communication disorders ranging from auditory processing disorders, to the aphasias as complications of neurological events, to stuttering and other non-fluencies in children and adults, to the many and varied disorders of language will necessitate a much more “global guardianship” than any single profession can provide. The nature and complexity of communication disorders is such that the collective decision making expertise of many disciplines whose specialized training and professional focus is unique to the nature of the communication disorder in question is required.

Human communication, as well as the huge variance in conditions that affect it, is so broad that the suggestion of its “guardianship” by any one profession is difficult to comprehend. This is particularly true for those professionals who have been engaged in an interdisciplinary methodology for decades. The breadth and complexity of many, if not most, communicative disorders assuredly necessitate a “team approach”. Trivializing the important work of those interdisciplinary team members will work against building the strong collaborations that are necessary to best serve those with communication disorders. For example, while we certainly acknowledge that skillful cochlear implantation by an otologist is a critical requisite for positive outcomes in patients, the surgical procedure itself is only a first step on the path to improved communication. Successful auditory habilitative/rehabilitative communication outcomes are achieved only with significant involvement and decision making by audiology and a host of other disciplines (i.e., education, education of the hearing impaired, psychology, social work, speech-language pathology, auditory-verbal therapist, etc.). In this specific case, ongoing “guardianship” of patient treatment, management and outcomes assessment for communication skills is primarily not the purview of the otologist unless a surgical complication develops. In addition, a narrowing of diagnostic and/or management decision making options for the spectrum of human communication disorders appears in stark contrast to recent mandates for the affordable, accessible, and effective outcomes driven healthcare system inherent to the current patient centered model in the United States today.

The need for collaboration across multiple disciplines in order to best serve patients with communication disorders has long been recognized. Indeed, the profession of audiology was conceived from the collaborations of an otolaryngologist (Norton Canfield, MD) and a psychoacoustician (Raymond Carhart, PhD) near the end of World War II. The evolution of audiology has developed and thrived precisely because services provided by otolaryngology alone are insufficient in restoring functional communication for those struggling with a wide range of auditory impairments. For nearly 70 years, otolaryngology and audiology have enjoyed a collaborative and interdependent relationship as important providers in the “communication industry” that also includes speech language pathology and a number of other important disciplines. Audiologists welcome and enjoy such working partnerships with various disciplines, including otolaryngology, as part of efforts to co-manage, treat and improve patient outcomes for those with a vast array of disorders impacting the spectrum of human communication. We continue to advocate for this collaboration across multiple disciplines in order to provide optimal treatment for patients with communication disorders. From this viewpoint guardianship of communication is the responsibility of any provider in the “communication industry“ and guardianship will cross multiple disciplines depending on patient needs and those most skilled to provide the primary service.